Clinical Features And Risk Factors Of Death In Acute Mushroom Poisoning

Objective: To analyze the clinical features and risk factors of death in acute mushroom poisonings patients.Methods : A total of 210 patients with acute mushroom poisonings who were enrolled in the hospital from July 2013 to November 2016 were recruited in our study.Clinical data include gender,age,length of hospital stay,incubation period,geographical distribution,clinical manifestations,laboratory indicators,specific treatment and clinical prognosis,etc.According to the prognosis,the patients were divided into survival group and fatal group,summarized the organ or system involvement and analyzed the clinical characteristics and focused on the risk factors of death patients.Results: 1.A total of 210 patients were included,survival group inclued 172 patients(81.9%)and fatal group inclued 38 patients(18.1%).There were 134 males and 76 females with age of [41.2,(26.8,56.0)] years;the highest mortality rate was observed in patients with acute mushroom poisoning with an incubation period of 6~24h.2.Clinical manifestations and organ and system involvement in patients with acute mushroom poisoning: more than 85% of patients had gastrointestinal symptoms,liver was the most affected organ,122 patients had liver damage,of which 86 survived and 36 died,mortality was up to 17.1%.Mortality rate of patients with coagulopathy and heart damage was 16.2% and 12.9%,respectively.The higher the number of organs or systems involved,the higher the mortality rate.3.Laboratory indicators of patients with acute mushroom poisoning:(1)Main abnormal indicators: patients mainly manifested as WBC,NEU,ALT,AST,DBil and LDH abnormally increased;(2)The comparison of laboratory indicators between the two groups: WBC,NEU,ALT,AST,DBil,PT,APTT,CK-MB and LDH in death group were significantly higher than survival group(P<0.05),while TC,ALB and PTA were obviously lower(P<0.05).(3)Single factor logistic regression analysis: WBC≥12×109/L,ALT≥200 U/L,AST≥200 U/L,LDH≥500 U/L,PT≥20 s,APTT≥40 s,PTA ≤60%,CK-MB≥5 μg/L and Mb≥100 μg/L were risk factors for death in patients with acute mushroom poisoning(P<0.001);(4)Multivariate logistic regression analysis: APTT≥40s was independent risk factors for death,APTT≥40s increased the risk of death by 5.35 times(OR=6.35,95%CI=1.24-32.44,P=0.026).4.Treatment of patients with acute mushroom poisoning:(1)general treatment: 114 patients were treated with diuretic,of which 87 survived and 27 died;74 patients were given antibiotics,of which 48 survived and 26 died;41 patients were given medication to improve coagulation,of which 26 survived and 15 died.That is to say,diuretics,antibiotics and drugs that can improve coagulation were significantly effective in improving the prognosis of patients with acute mushroom poisoning,the difference was statistically significant(P=0.001).(2)Blood purification treatment: 86 patients were treated with plasma exchange,of which 61 survived and 25 died;53 patients received hemoperfusion,of which 38 survived and 15 died,the difference was statistically significant(P<0.05).It shows that plasma exchange and hemoperfusion have a positive effect on the treatment of acute mushroom poisoning.Conclusion: 1.The mortality of patients with acute mushroom poisoning is high,and liver is the most important damaged organ.2.WBC,ALT,AST,LDH,PT,APTT,PTA,CK-MB and Mb levels have a guiding role in early judgment of patients’ prognosis.APTT≥40 s is an independent risk factor for death.3.Diuretic,anti-infective,improve coagulation and blood purification have significant effects on improving the prognosis of patients with acute mushroom poisoning.The most effective treatment of blood purification is plasma exchange.